A comparison of end-to-end staple and suture colorectal anastomosis in the dog
Polglase, A.L.; Hughes, E.S.; McDermott, F.T.; Pihl, E.; Burke, F.R.
Surgery Gynecology and Obstetrics 152(6): 792-796
1981
ISSN/ISBN: 0039-6087 PMID: 7017978 Document Number: 170948
A comparison of end-to-end stapled and sutured colorectal anastomoses was made in the dog. The rectosigmoid region was divided and anastomosis was achieved using the end-to-end stapling instrument or a single layer had sewn technique. Two of 12 dogs in each group were sacrificed on days 0, 2, 4, 6, 8 and 10 postoperatively. Roentgenographic examination, pressure testing and macroscopic and microscopic evaluation of the anastomoses were undertaken. Significantly less anastomotic narrowing for the stapled anastomoses due to a reduced inversion of tissue was revealed. Mucosal healing was significantly delayed for the stapled anastomoses as compared with the sutured anastomoses. No significant difference was noted in the amount of anastomotic edema between the 2 anastomoses. The 2 forms of anastomoses were hermetic from the time of construction. The clinical implications of these findings are important. The reduced inversion by the staple anastomosis may be associated with less mechanical impedence of stool for anastomoses between intestine of narrow lumen. The similar edema content for the 2 types of anastomoses suggests that design modification of the end-to-end anastomotic instrument is required to reduce compressive trauma between anvil and cartridge. The predictable hermetic nature of a properly constructed stapled anastomosis allows a more objective and rational decision to be made about the requirement for a proximal mitigating stoma after low colorectal anastomosis. The delayed mucosal healing at the site of a staple anastomosis may prove to be a factor of importance in relation to anastomotic stenosis.